Pros and Cons of Locum Tenens Work

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Locum Tenens is simply a fancy Latin way of saying temporary work. Just like curriculum vitae is a fancy Latin way of saying resume. We doctors seem to be fans of fancy Latin words. Why? Nolo contendere. Non est mea culpa.

I’ve worked as a locum in a variety of situations and for a variety of reasons. I detailed those in a guest post at the WhiteCoatInvestor. I’ve also discussed some good reasons to choose locum tenens work. Today, I’d like to discuss some of the pros and cons of locum tenens work. Sic infit.

 

 

Grace Cathedral door

latin people doing latin things

 

Pro: Locums gives you freedom.

 

Freedom is something I write about a fair amount. An oft-used synonym for Financial Independence is Financial Freedom. Choosing to work as a locum gives you a whole lot of freedom, a freedom that can be gained without choosing to retire.

As a locums doc, you can choose to work as little or as much as you like. You can work in major metropoles, or podunk mountain towns. You can make like a schoolteacher and take your summers off. If you’ve grown tiresome of your surroundings, you can make like a hockey player and get the puck outta here. You can travel the country in an RV, hopping from job to job, or stay put, accepting jobs only in your hometown.

 

Con: Freedom isn’t free.

 

Freedom can come with a hidden cost, the lack of job stability. You know the tablecloth trick, the one where you pull the tablecloth out really fast, and usually the dishes all stay put? But sometimes they don’t?

Several times, I’ve had the tablecloth pulled out once I had fully set the table, signed a contract, and even started working a locum tenens assignment. Your temporary employer usually retains the rights to cancel a job on short notice, a factor to consider when you negotiate a contract via an agency or independently.

The first time it happened to me, the dishes nearly crashed hard. I was told on very short notice that my agency had a malpractice insurance lapse, and that I wouldn’t be able to work for at least a couple weeks. This was maybe six or eight weeks into a 25-week assignment, my first long-term assignment in the fall after completing residency. I wasn’t about to accept the agency’s “solution” of an extended unpaid vacation.

 

yes, it was

 

Knowing that multiple agencies had advertised the position, I reached out to one of them and found that they could provide immediate malpractice insurance which would allow me to keep working. There were two or three days of discussions between the two agencies, the anesthesia group, and the insurance companies, so I did get a long-weekend, but the offending agency agreed to pay me for the days I missed, so all was well in the end. I ended up working for the second agency for two weeks, and I finished out the contract under the first agency. If I hadn’t stood up for myself, no one else would have.

On another occasion, my dishes were left more or less intact when the tablecloth vanished. A nine-month assignment was cancelled when a permanent doc was found. I was given enough notice to find a different job, one that was actually closer to where I wanted to be while my wife was interning as a dietitian. In the end, the new job was probably better than the first, and offered more flexibility.

A third time it happened to me was a bit frustrating, as I had requested a specific week off from my full-time job to match another facility’s need. The need went away, and I had a nice little staycation with my young family. Talis est vita.

 

Pro: Locum tenens work pays well.

 

Unlike positions with partnership tracks, locum tenens positions pay well from day one. If you are qualified to do the job, you are paid accordingly. If you are a new graduate and used to working like a resident, you will find working a similar schedule as a locum can be quite lucrative.

With most locum tenens contracts I’ve signed, every quarter-hour you work beyond an 8-hour day is rewarded with additional pay. Call coverage can generate additional income. A hard-working locum can probably earn close to double that of a colleague putting in his or her time in hopes of becoming partner.

 

Con: Locum tenens pay can be bested.

 

While locums can be advantageous, particularly for a new graduate, it can be tough to match the salary of some experienced physicians in private practice.

With hard work, you can make a well above-average salary as a locum, but the most remunerative jobs are going to belong to physicians who have reached partnership in an area with a good payor mix. I’ve done well as a locum, and as an employed physician, but never as well as the partners in a suburban practice with whom I once interviewed.

 

mackinac waterfront

locums don’t live here

 

Pro: You only pay for the benefits you want.

As a locum, you are an independent contractor, and you choose your own benefits. Most physicians who are employed or part of a larger group will be assigned a benefits package. The options and flexibility of these benefits vary widely, but the options can be limited.

For example, I am employed and have an excess group life policy as part of my benefits package. I didn’t choose it, and don’t need or really want it, but it’s provided to all physicians employed by the hospital. Although I don’t directly pay for it, I do pay taxes on the provided benefit.

Similarly, an employed physician will have access to defined contribution and / or defined benefit retirement plans, but the investment options can be limited to lousy investments. Dr. Dahle, the White Coat Investor has devoted a post to the topic of choosing funds in a crummy 401(k). As an independent contractor, you can start a solo 401(k), stashing away up to $53,000 tax-deferred, choosing any investments you wish.

 

Con: Your benefits plan will be a DIY endeavor.

 

While your options for health, life, and disability insurance are unlimited, it is up to you to find them. Yes, there are good people out there to help you with the task, but you must take the initiative and make it happen.

A solo 401(k) is a great way to save for retirement while reducing your current tax burden, but you will not benefit from any corporate match or profit sharing program. Currently, my employer kicks in about $20,000 a year to my 401(k). As a locum, you’re on your own, for better or for worse.

 

unattended children will be sold lagunita

the danger of being on your own

 

Pro: Locum tenens physicians can avoid office politics.

 

A locum tenens physician can easily steer clear of many of the non-clinical duties that are increasingly expected of more permanent “providers.”

If meetings and conflict resolution are not your thing, locums might be for you. If you’re not totally into reviewing and revising policies, rules, and regulations, locums is where it’s at. The buck circumvents you and lands squarely on someone else’s desk. You’re there to practice medicine, and that’s pretty much all that will be expected of you.

 

Con: You’re just a short-timer.

 

Being a transitory figure isn’t always a blessing. If you’re used to being an authority figure, you might struggle working in a facility with shortcomings, particularly if you know how to fix them. Your input won’t be sought and may not be taken seriously when provided. You will need to adapt to the local facility’s culture, even if it doesn’t jive well with your way of doing things.

Socially, your ephemeral presence may leave you high and dry when it comes to work parties and social gatherings. Some functions are reserved for the active medical staff, a mailing list you probably won’t be on. More informal gatherings might go down with or without you. In my experience, I have felt quite welcomed by my new and temporary colleagues, but I wouldn’t expect that to always be the case.

If you’ve got a pro or con to add, please do so below. If you’ve got a lot to say, the readers and I would love to see a guest post from another experienced locum tenens physician. I’m easy to contact if you might be interested.

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10 comments

  • MM

    Another pro: If you do a good job at a particular locums assignment, the hospital is more willing/flexible to accommodate the schedule to fit yours… I find that to be the case for me and some of my colleagues who do locums work.

    • Excellent point. A dependable locums doc can be a hot commodity.

      In my experience, if and when a permanent position becomes available, a solid locums doc will have the right of first refusal before the search widens. I’ve accepted a couple “permanent” opportunities and turned down many more from facilities where I have worked in the past.

      Thanks for chiming in!
      -PoF

  • I’m not a physician but I’ve been in healthcare finance and operations for more than 20 years. I am a fan of using locums. In fairness, most of my career has been in workers’ comp which is a good fit for locums as there isn’t the same doctor / patient relationship that you get in other specialties.

    It’s great that there is such a strong market for locums. As a FIRE physician, having the opportunity to earn at a high rate on your own terms is very appealing.

  • Interesting post PoF! Love that pic about selling children to the circus!

  • I appreciate you explaining the benefits of locums tenens work when it comes to benefits, stability, and opportunity. I think that this type of work may be good for doctors who have a very independent personality. It’s a great way to get around and see different facilities as well. I think there is a lot to learn by seeing and working in different locations.

  • Happy1

    I have only worked short term locum assignments. The cons concerning locums is the application necessary to receive hospital privileges is the same for locums and permanent physicians. On your CV , you must include the asignment if it is one day or one year.

  • Gidna Delorme

    My name is Gidna Delorme, and I am a National Recruiting Agent. Anyone who is interested in finding out more about locum opportunities please do not hesitate to contact me, my contact information is listed below. I look forward to working with you all!


    Gidna Delorme
    ASSOCIATE RECRUITER
    Phone: 561-348-5566
    Email: gdelorme@bartonassociates.com
    Fax: 888-730-4328

  • Oncologist

    The Real Story

    To be a locum provider ask yourself are you OK with 25-35 percent of your hourly wage going to the agency in the form of net profit? If yes, then go for it, there are many opportunities – as some clinics are in dire need of staffing. If no, then it is not a viable alternative career choice for you.

    I have one year of locum tenen experience. I have experience with multiple locum agencies and I have worked locum jobs. I have also spent a great deal of time applying for locum work without an agency.

    I tried locum work because the responsibility of a full time position did not allow me sufficient time with my young kids. The following is what I have learned. The locum agencies net a minimum profit of 25% of a physicians pay for every hour that the physician works (often the percentage is much higher, as some locum companies advertise an average of 35% net to their shareholders). It can be even higher, if they find a physician to work for less (they start negotiating at little over a third of what the clinic is willing to pay for you). So what do they provide for attempting to hire you at the lowest possible pay scale? They provide malpractice insurance, which comes from the gross money the clinic pays not from the net profit the locum company makes. They provide housing and travel, again this comes from the gross charge to the clinic not the net profit the locum agency makes. Finally, they report that they help with credentialing, which is also misleading. There help consists of passing along the credentialing paperwork for the doctor to fill out. Essentially, these companies do nothing besides leverage access to these jobs for 25-35% of your hourly wage in net profit (the brutal trifecta that allows the current system 1. hospitals do not like to advertise that they need physicians, 2. the hospital has already signed a contract with a locum agency, and 3. many hospitals have outsourced staffing, see below).

    Many hidden dangers for doctors… many clinics have signed contracts with locum tenen companies. In those agreements are 24 month clauses that if they were the first to present a doctor’s CV, then for the next two years if that doctor decides to work at that clinic they get a percentage or 20 to 30K permanent placement bonus. For example, many healthcare systems are statewide or include multiple states. If you agree to have your CV sent to one small town clinic owned by a multiple state wide healthcare system, the agency will get a percentage or placement fee if you end up working at another site in another state at another time within the 24 months. Even if you never agreed to that because the clinic already did – remember there are two contracts that the locum agency has – one with you, and one with the healthcare system.

    So what is a doctor to do? You can make a living and spend more time with your family, if you are comfortable with these agencies making that type of net profit on every hour you work – otherwise locum tenen work is not for you. As a physician in the current system, you really do not have much of a choice. Someone might ask, “What about contacting clinics directly”? Unfortunately, it is possible to score a locum job, but extremely difficult for the following reason. I have found that many clinics and hospitals have outsourced their hiring to staffing agencies that are independent contractors. These staffing contractors lack the incentive to assist locum providers (very difficult to even get in the front door). Also, if the hospital/clinic has a locum need they sign with an locum agency like comp health as to not directly advertise that they need physicians. Thus, it is very difficult (not impossible) for a doctor to find locum positions without an agency.

    As for me, I felt a 25 to 35% of my wage in net profit just to have access to the job was predatory, and I have stopped working as a locum. A job site where locum tenen needs can be anonymously posted by the clinic would change the current dynamic.

    • I understand your frustrations, Oncologist. Almost makes you want to start your own locums company, doesn’t it? Have four or five docs places and you’re making as much as the docs doing all the work!

      I still made what I thought was good money in spite of the fees, and the couple times I negotiated my own deal, I was not in a position of strength and I actually made less than I did in other locums jobs. One was a working interview and the other was a spot where I wanted to be and contacted the facility asking if I could work there over the summer.

      A model I really like is the one started by Lucidity Direct. They are relatively new, and most if not all of the currently posted jobs are for ER docs, but they are aiming to be something like the Uber or Airbnb for locums jobs. They allow you to negotiate directly with the group / facility, and rates are transparent. Lucidity does collect a fee, but my understanding is that it’s a small fraction of what the locums agencies typically collect. Hopefully, they will have oncology and / or anesthesia positions soon.

      Best,
      -PoF

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